Central
HEALTH INSURANCE CLAIMS SETTLEMENT
Updated on:19th Mar, 2021
1. Reference is drawn to the provisions of Regulation 27 (Settlement/Rejection of claim by insurer), Regulation 30 (Administration of Health Policies) and Regulation 33 (Engagement of Services of TPAs by Insurers in relation to Health Insurance Policies) of the IRDAI (Health Insurance) Regulations, 2016, Regulation 21 (3) (c) (i) (b) of IRDAI (Third Party Administrators - Health Services) Regulations, 2016 and circular Ref: IRDAI/CAD/CIR/PPHI/059/04/2019 dated 10.04.2019 regarding information to be provided to the insurance policyholders/claimants about various insurance policy services. 2. It is essential that all insurers establish procedures to let policyholders get clear and transparent communication at various stages of claim processing. As specified in the within referred circular dated 10.4.2019, all the insurers shall ensure putting in place systems to enable policyholders track the status of cashless requests/ claims filed with the Insurer/TPA through the Website/Portal/App or any other authorized electronic means on an ongoing basis. The status shall cover from the time of receipt of request to the time of disposal of the claim along with the decision thereon. ,....
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